Healthcare Provider Details

I. General information

NPI: 1366535007
Provider Name (Legal Business Name): SANDRA L GIACOMETTI MA,LPC,CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 SCENIC DR
CLARKS SUMMIT PA
18411-9209
US

IV. Provider business mailing address

6692 SOARING EAGLE WAY
SARASOTA FL
34241-5212
US

V. Phone/Fax

Practice location:
  • Phone: 570-313-9141
  • Fax: 800-342-1985
Mailing address:
  • Phone: 570-313-9141
  • Fax: 800-342-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3071
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18233
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002310
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: